一个倡议,以促进基于价值的压力测试选择在初级保健和心脏病诊所:一个混合方法评估评估
Samantha M R Kling1, Neil M Kalwani2,3, Marcy Winget1
1Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
一项倡议改善了在初级保健和心脏病诊所使用运动压力心电图 (压力心电图) 与心声回声图 (压力回声) 的使用. 基于价值的教育和缩短报告时间是增加适当测试订单的关键.
科学领域:
- 心脏病学 心脏病学
- 医疗保健管理的管理
- 临床实践指南 临床实践指南
背景情况:
- 运动压力回声心电图 (压力回声) 经常被过度使用.
- 运动压力心电图 (压力心电图) 提供了一个低成本,适当的替代方案.
- 基于价值的医疗保健计划旨在优化诊断测试的利用率.
研究的目的:
- 评价一项倡议,促进压力ECG与压力回声的指导方针一致的排序.
- 评估报告处理时间缩短,针对性教育和临床决策支持对订单实践的影响.
- 了解临床医生对初级保健和心脏病学环境中的倡议的看法.
主要方法:
- 使用混合方法方法来评估压力测试订单的变化.
- 在三个时期收集数据:基线,干预期1 (缩短交付时间+教育),干预期2 (增加电子健康记录警报).
- 与初级保健提供者和心脏病专家进行了调查和采访.
主要成果:
- 在初级保健 (38%) 和心脏病诊所,压力心电图的百分比从基线显著增加.
- 缩短心电图报告的处理时间和基于价值的教育对于初级保健的采用至关重要.
- 虽然初级保健提供者发现警报具有影响力,但订购变更是适度的;心脏病学家更多地依赖专业知识,但却看到警报的心电图订单增加.
结论:
- 该倡议成功地影响了初级保健和心脏病学的诊断测试订购行为.
- 临床医生对干预措施的看法因专业而异,并不总是与观察到的行为变化相关.
- 优化使用压力ECG作为压力回声的替代品,需要根据提供者的专长和工作流程量身定制的策略.
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